早期肠屏障功能保护在重症急性胰腺炎治疗中的重要性  

Importance of early intestinal barrier protection in severe acute pancreatitis

作　　者：刁永鹏 陈宏[2] 李非[2] 杨磊[2] 刘大川[2] 朱研[2] 许庆 

机构地区：[1]北京市中关村医院普外科,100190 [2]首都医科大学宣武医院普外科

出　　处：《中华肝胆外科杂志》2011年第6期462-465,共4页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的观察早期保护肠屏障功能对重症急性胰腺炎（SAP）患者的影响。方法分析56例SAP患者的治疗方法和预后。随机数字表法将患者分为常规治疗组（A组）和肠屏障保护组（B组），比较两组患者不同时间的APACHEⅡ评分、Ranson评分、Marshall评分、CT严重指数（CTSI）、胃肠功能评分、尿乳果糖／甘露醇（L／M）比值、血浆内毒素和二胺氧化酶（DAO）、血清C反应蛋白（CRP）和肿瘤坏死因子α（TNF-α）、胰腺感染和多器官功能障碍综合征（MODS）发生率、住院病死率。结果治疗后第7天，B组APACHEⅡ评分、胃肠功能评分、尿L／M比值、血浆内毒素和DAO、血清CRP和TNF-α较A组显著降低，差异有统计学意义（P〈0．05）。入院2周内，两组患者CTSI比较，差异无统计学意义（P〉0．05）；B组患者胰腺感染和MODS发生率明显低于A组，差异有统计学意义（P〈0．05）；两组住院病死率比较，差异无统计学意义（P〉0．05）。结论早期保护肠屏障功能，能明显减轻SAP患者的全身炎症反应，降低胰腺感染和MODS发生率，从而改善其预后。Objective To observe the influence of early intestinal barrier protection in patients with severe acute pancreatitis（SAP）. Methods To analyze the therapeutic methods and prognosis of 56 patients with SAP. The patients were randomly divided into the conventional therapy group （A） and the intestinal barrier protection group （B）. The APACHE Ⅱscore, Ranson score, Marshall score, CT severity index （CTSI）, gastrointestinal functions score （GFS）, the ratio of Lactulose to Mannitol （L/M）, plasma Endotoxin and Diamine Oxidase （DAO）, serum C-reactive protein （CRP） and TNF-α, incidence of pancreatic infection and multiorgan dysfunction syndrome （MODS）, and the hospitalization mortality were compared between the two groups. Results On the 7th day after admission, the APACHE II score, GFS, L/M, Endotoxin, DAO, CRP and TNF-α were significantly less in group B than in group A （P〈0.05）. There was no significant difference in the CTSI （P〉0.05） between the two groups at 2nd week after admission. The incidence of pancreatic infection and MODS in group B were significantly lower than in group A （P〈0.05）. The hospitalization mortality was not significantly different （P〉0.05） between the two groups. Conelusion Early intestinal barrier protection in SAP alleviated systemic inflammatory response, and reduced the incidences of pancreatic infection and MODS, thus improved the prognosis.

关 键 词：胰腺炎 肠屏障 预后 

分 类 号：R576[医药卫生—消化系统]